Healthcare for All

As advocates who follow in the footsteps of earlier generations to fight for good causes, Friday’s decision on the Affordable Care Act by the 11th Circuit Court of Appeals feels familiar. Most major pieces of social legislation have been challenged in the courts, including the Social Security Act in the 1930s and the Civil Rights Act of 1964. Today, those laws are part of the fabric of American society. I’m confident the Affordable Care Act will be as well.

And while the court struck down part of the Affordable Care Act, buried in the more than 300 pages of opinions are some important positive developments.

The 11th Circuit struck down the individual responsibility provision by a 2-1 vote, finding it to be beyond Congress’s authority under the Constitution’s commerce clause. As a practical matter, this ruling has no immediate impact. In June, the Sixth Circuit Court of Appeals reached the opposite conclusion and upheld the individual responsibility provision. On the scoreboard, we’re tied, 1-1.

Basically, this all just means that what we have assumed all along is true-it will ultimately be up to the Supreme Court to resolve the issue. And most constitutional experts continue to believe that if the high court follows existing precedents, it will uphold the law.

But Friday’s decision is just as important for what it did not do. The appeals court refused to strike down the entire Affordable Care Act, as the lower court had done. Instead, it explicitly found that even if the individual responsibility provision fails, the rest of the law is not affected. The important work ahead, such as building state health care exchanges, planning for tax credits to make insurance affordable, and eliminating restrictions for everyone with pre-existing conditions, can continue uninterrupted.

On Medicaid, the news is doubly good. The 26 states that brought this case had challenged the Medicaid expansion as unconstitutionally “coercive” of the states-even though between 90 to 100 percent of the costs of that expansion are paid for by the federal government-and the court rejected their argument. Because this is the only case nationally in which the Medicaid claim is raised, there’s a reasonable chance that the Supreme Court will not even review the issue, and the Medicaid coverage that will make such a profound difference in the lives of people with low incomes will roll out in 2014 as scheduled.

Friday’s ruling is undoubtedly a disappointment for all of us who care about ensuring access to high-quality, affordable health care for all Americans. But amidst the Monday morning quarterbacking, we should not despair. This is just another round in a long process.